* Four Republican governors back Medicaid expansion
* 13 Republican governors oppose the plan
* Another 15 may be about to decide their positions
By David Morgan
WASHINGTON, Jan 16 At least 22 U.S. governors,
including four Republicans, support an expansion of Medicaid
under President Barack Obama's healthcare reform law, while
others are expected to decide in the coming weeks, experts said
An analysis published by the New England Journal of Medicine
said the headcount, which includes 13 Republican governors who
staunchly oppose Medicaid expansion, portends an uneven start
for "Obamacare" when its most sweeping reform provisions begin
on Jan. 1, 2014.
"No clear consensus has emerged," said the authors of the
article, Harvard physicians Benjamin Sommers and Arnold Epstein.
"It now appears that the (law's) 2014 coverage expansion will
have large unintended gaps, as low-income adults in at least a
dozen states remain ineligible for any kind of public subsidy
for health insurance."
The analysis provides a snapshot of the Medicaid acceptance
among states as most governors and state lawmakers prepare for
their last legislative session before the law takes effect. A
governor's position does not necessarily indicate whether a
state will embrace the expansion because many require action by
The Patient Protection and Affordable Care Act, the
signature domestic achievement of Obama's first term, calls for
expanding the Medicaid program for the poor to include Americans
living near the poverty line. In many states, current Medicaid
benefits are limited mainly to children and pregnant women.
The expansion is intended to bring 16 million uninsured
people into the $2.8 trillion U.S. healthcare system. But many
states, which would pay less than 10 percent of the cost under
the law, have balked at the potential budget impact or rejected
the prospect of participating in a new government program.
States that oppose the expansion can continue to operate
their current Medicaid programs with federal matching funds.
Since Obama's reelection, eight governors have chosen to
support the Medicaid expansion, including the Republican
governors of Arizona, Nevada, New Mexico and North Dakota. Five
Republicans have chosen to oppose it.
Another 15 governors -- 13 Republicans and two Democrats --
remain undecided. But experts say many of them are likely to
reach decisions in coming weeks as they propose new budgets for
the fiscal year beginning July 1.
"We're looking to those current budgets, particularly for
state that have been undecided, to see if they might have a more
definitive position," said Robin Rudowitz, a Medicaid expert
with the nonpartisan Kaiser Family Foundation, which tracks